COMPARISON OF EXCESS COSTS OF CARE AND PRODUCTION LOSSES BECAUSE OF MORBIDITY IN DIABETIC-PATIENTS

OBJECTIVE - To assess and compare excess costs of care and production losses because of morbidity in diabetic patients and the general popul ation of a Swedish community. RESEARCH DESIGN AND METHODS- Costs of pr oduction losses were calculated from medical and social insurance reco rds on sickness benefit days (shortterm illness) and premature retirem ent (permanent disability) in people with diabetes and in the entire p opulation of the community (a municipality comprising a town and rural surroundings, with 28,000 inhabitants). Care costs included those of consultations and inpatient care, as well as costs of insulin, oral an tidiabetic medications, other drugs, test material, and treatment devi ces, and they were obtained from patient records, the health care admi nistration, and the statistics of community pharmacy sales. RESULTS - Of the diabetic patients <65 years of age, above which both diabetic a nd nondiabetic people get retirement pension, and sickness benefits ce ase, 62% of those on insulin treatment in each gender had insulin-depe ndent diabetes mellitus (IDDM). All insulin-treated non-insulin-depend ent diabetes mellitus (NIDDM) patients were >40 years of age. Both the insulin-treated and the non-insulin-treated diabetic patients were pr ematurely retired twice as often as the average population and had twi ce as many inpatient days. The insulin-treated subjects also had twice as many sickness benefit days. The excess costs of production losses as a result of morbidity in people with diabetes were about $7,000 per individual and year. The corresponding excess costs of inpatient care were $800. The therapeutic expenditures for control of diabetes were about $600 per individual and year. If converted to U.S. conditions, t he costs of lost production as a result of excess morbidity (<65 years of age) would be $12 billion and $9 billion for people with insulin-t reated and non-insulin-treated diabetes, respectively. CONCLUSIONS - I f improved metabolic control by intensified treatment would reduce exc ess morbidity in both IDDM and NIDDM, the predominant costs of product ion losses imply that intensified antidiabetic treatment might save co sts.